Splenic Artery Pseudoaneurysms: The Role of ce-CT for Diagnosis and Treatment Planning

Abstract

Splenic artery pseudoaneurysm (PSA) is a contained vascular wall lesion associated with a high mortality rate, generally related to pancreatitis, trauma, malignancy, iatrogenic injury, and segmental arterial mediolysis. Computed tomography angiography allows us to visualize the vascular anatomy, differentiate a PSA from an aneurysm, and provide adequate information for endovascular/surgical treatment. The present review reports on the main state-of-the-art splenic artery PSA diagnosis, differentiating between the pros and cons of the imaging methods and about the endovascular treatment.

Keywords: MDCTA; angiography; embolization; splenic artery pseudoaneurysm.

Figure 1

(a–d). A 60-year-old man with a walled off necrosis after necrotizing pancreatitis. (a,b) Axial and sagittal MPR reconstruction images demonstrate splenic artery PSA (circle) in direct connection with a walled-off necrosis, previously treated surgically. (c) Angiographic images of splenic artery PSA (arrow in (c)). (d) Final angiographic control after coil embolization demonstrates splenic artery recanalization distal to coil embolization by magna pancreatic artery.

Figure 2

(a–d). A 20-year-old man presented to our emergency department after high blunt trauma. (a,b) Axial and coronal MPR reconstruction images demonstrate splenic artery PSA, rounded by coarse hematoma (circle). (c) Digital subtraction angiography of splenic artery demonstrates PSA (arrow) with the presence of multiple wall irregularities, such as blebs (a warning sign of an impending breakout). (d) Post-embolization angiographic control with complete embolization of the splenic artery. There are also other coils due to another adrenal hemorrhage, successfully treated in the same session.

Figure 3

(a–d). A 45-year-old woman presented a massive hematemesis after gastroentero-anastomosis due to ingestion of caustics. (a,b) Coronal and axial MPR reconstruction images demonstrate a spastic splenic artery with PSA formation directly bleeding in the stomach (circle). (c) Digital subtraction angiographic image shows splenic artery PSA rupture with massive bleeding in the stomach. (d) Post-embolization angiographic control shows complete occlusion of the splenic artery obtained with 1:1 mixture Glue/Lipiodol.

Figure 4

(a–d). A 55-year-old man presented to our emergency department for acute abdominal pain. (a,b) Axial MIP reconstruction images demonstrate celiac trunk dissection with multiple beading or webs, aspects of the splenic artery suggestive of SAM. (c) Digital subtraction angiographic image that shows multiple beading and webs of the splenic artery vessel wall. (d) Post-embolization angiographic control, after very proximal embolization for impossibility to more distal catheterization, demonstrating distal recanalization of splenic artery by gastroduodenal artery.